﻿CREATE TABLE [dbo].[CLM_837I_2320_OtherSubscriberInformation]
(
[OtherSubscriber_SBR01_Payer_ResponsibilitySeqNumberCode] [nvarchar] (1) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriber_SBR02_IndividualRelationshipCode] [nvarchar] (2) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriber_SBR03_InsuredGroupOrPolicyNumber] [nvarchar] (30) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriber_SBR04_OtherInsuredGroupName] [nvarchar] (60) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriber_SBR09_ClaimFilingIndicatorCode] [nvarchar] (2) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[PayerPriorPayment_AMT02OtherPayerPatientPaidAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[COBAllowedAmount_AMT_AMT02_AllowedAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[COBSubmittedCharges_AMT_AMT02_COBTotalSubmittedChargeAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[DRGOutlierAmount_AMT02_ClaimDRGOutlierAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[COBMedicarePaidAmount_AMT02_TotalMedicarePaidAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[MedicarePaidAt100Amount_AMT02_MedicarePaidAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[MedicarePaidAt80Amount_AMT02_MedicarePaidAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[COBMedicareATrustFundPaidAmount_AMT02_PaidFromPartAAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[COBMedicareBTrustFundPaidAmount_AMT02_PaidFromPartBAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[COBTotalNonCoveredAmount_AMT02_NonCoveredChargeAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[COBTotalDeniedAmount_AMT02_ClaimTotalDeniedChargeAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberDemographic_DMG02_OtherInsuredBirthDate] [nvarchar] (35) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberDemographic_DMG03_OtherInsuredGender] [nvarchar] (1) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherHealthInsurance_OI03_BenefitsAssignmentCertification] [nvarchar] (1) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherHealthInsurance_OI06_ReleaseOfInformationCode] [nvarchar] (1) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA01_CoveredDaysOrVisits] [nvarchar] (15) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA02_LifetimeReserveDays] [nvarchar] (15) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA03_LifetimePsychiatricDays] [nvarchar] (15) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA04_ClaimDRGAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA05_RemarkCode] [nvarchar] (30) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA06_ClaimDispShareAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA07_ClaimPassThroughAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA08_ClaimPPSCapitalAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA09_PPSCapitalFSPDRGAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA010_PPSCapitalHSPDRGAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA011_PPSCapitalDSHDRGAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA012_OldCapitalAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA013_PPS_CapitalIMEAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA014_PPSOperHospSpecificDRGAmt] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA015_CostReportDayCount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA016_PPSOperatingFedSpecificDRGAmt] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA017_ClaimPPSCapitalOutlierAmt] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA018_ClaimInderectTeachingAmt] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA019_NonpayableProfComponentAmt] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA020_RemarkCode] [nvarchar] (30) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA021_RemarkCode] [nvarchar] (30) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA022_RemarkCode] [nvarchar] (30) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA023_RemarkCode] [nvarchar] (30) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[InpatientAdjudication_MIA024_PPSCapitalExceptionAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OutpatientAdjudication_MOA01_ReimbursementRate] [nvarchar] (50) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OutpatientAdjudication_MOA02_HCPCSPayableAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OutpatientAdjudication_MOA03_RemarkCode] [nvarchar] (30) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OutpatientAdjudication_MOA04_RemarkCode] [nvarchar] (30) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OutpatientAdjudication_MOA05_RemarkCode] [nvarchar] (300) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OutpatientAdjudication_MOA06_RemarkCode] [nvarchar] (30) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OutpatientAdjudication_MOA07_RemarkCode] [nvarchar] (30) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OutpatientAdjudication_MOA08_ESRDPaymentAmount] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OutpatientAdjudication_MOA09_NonPayableProfComponentAmt] [nvarchar] (18) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberName_NM102_EntityTypeQualifier] [nvarchar] (1) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberName_NM103_LastNameOrOrgName] [nvarchar] (35) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberName_NM104_OtherInsuredFirstName] [nvarchar] (35) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberName_NM105_OtherInsuredMiddleName] [nvarchar] (25) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberName_NM107_NameSuffix] [nvarchar] (10) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberName_NM108_IdentificationCodeQualifier] [nvarchar] (2) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberName_NM109_OtherInsuredIdentifier] [nvarchar] (80) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberAddress_N301_SubscriberAddress1] [nvarchar] (55) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberAddress_N302_SubscriberAddress2] [nvarchar] (55) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberCity_N401_CityName] [nvarchar] (30) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberCity_N402_StateOrProvince] [nvarchar] (2) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberCity_N403_PostalCode] [nvarchar] (15) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherSubscriberCity_N404_CountryCode] [nvarchar] (3) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherPayerName_NM103_LastNameOrOrganizationName] [nvarchar] (35) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherPayerName_NM108_IdentificationCodeQualifier] [nvarchar] (2) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherPayerName_NM109_OtherPayerPrimaryIdentifier] [nvarchar] (80) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherPayerAddress_N301_PayerAddress1] [nvarchar] (50) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherPayerAddress_N302_PayerAddress2] [nvarchar] (55) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherPayerCity_N401_CityName] [nvarchar] (30) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherPayerCity_N402_StateOrProvince] [nvarchar] (2) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherPayerCity_N403_PostalCode] [nvarchar] (15) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherPayerCity_N404_CountryCode] [nvarchar] (3) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[ClaimAdjudicationDate_DTP_AdjudicationOrPaymentDate] [nvarchar] (35) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherPayerPriorAuthOrRef_REF01_ReferenceIDQualifier] [nvarchar] (3) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherPayerPriorAuthOrRef_REF02_PriorAuthOrReferralNumber] [nvarchar] (30) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherPayerPatientInfo_NM108_IdentificationQualifier] [nvarchar] (2) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[OtherPayerPatientInfo_NM109_IdentificationCode] [nvarchar] (80) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[IDKey] [int] NOT NULL IDENTITY(1, 1),
[Subscriber_HL01_SubscriberHierarchicalIDNumber] [nvarchar] (12) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[Patient_HL01_PatientHierarchicalIDNumber] [nvarchar] (12) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[BTSMessageId] [nvarchar] (100) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[BTSInterchangeId] [nvarchar] (100) COLLATE SQL_Latin1_General_CP1_CI_AS NULL
) ON [PRIMARY]


